title: [Fulminant hepatic failure induced by intermediate dose methotrexate in a case of non-Hodgkin's lymphoma].
abstract: Methotrexate (MTX) is frequently used as an antifolics agent in many malignant neoplasms such as leukemia, lymphoma and osteosarcoma. The major side effects of MTX are liver and renal damages, bone marrow suppression and so on. But careful management and citrovorum factor rescue could decrease the incidence and degree of these side effects. In this report, we described a patient with non-Hodgkin's lymphoma who developed and died of fulminant hepatic failure soon after the administration of intermediate dose MTX. Serological tests for HB virus were not changed throughout, and lymphocyte stimulation test for MTX was strongly positive. His autopsy revealed no inflammatory cell infiltration into the liver, but marked biliary congestion which is a distinctive feature of drug induced hepatitis. From above results, it was suggested that nature of this fulminant hepatic failure was an allergic reaction to MTX. There is no previous report which is concerning about MTX and fetal drug related hepatic failure.
authors.affiliation: Department of Internal Medicine, Kashiwa Hospital, Jikei University School of Medicine.
authors.forename: K
authors.initials: K
authors.lastname: Kaito
authors.forename: T
authors.initials: T
authors.lastname: Katayama
authors.forename: M
authors.initials: M
authors.lastname: Yoshida
authors.forename: A
authors.initials: A
authors.lastname: Saito
authors.forename: M
authors.initials: M
authors.lastname: Kobayashi
authors.forename: S
authors.initials: S
authors.lastname: Ochiai
authors.forename: S
authors.initials: S
authors.lastname: Masuoka
authors.forename: T
authors.initials: T
authors.lastname: Shimada
authors.forename: K
authors.initials: K
authors.lastname: Nishiwaki
authors.forename: O
authors.initials: O
authors.lastname: Sakai
mesh_terms: D000328:Adult; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology* / Q000473:pathology; D004342:Drug Hypersensitivity / Q000209:etiology*; D006801:Humans; D008099:Liver / Q000473:pathology; D008228:Lymphoma, Non-Hodgkin / Q000150:complications*; D008297:Male; D008727:Methotrexate / Q000009:adverse effects*
chemical_list: D008727:Methotrexate